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Since psychological problems originate from childhood repressed impulses and conflicts, the aim of psychoanalysis is to bring repressed feelings into conscious awareness where the patient can deal with them
Teaches people adaptive ways of thinking and acting based on the assumption that thoughts intervene between events and our emotional reactions
When energy devoted to id-ego-superego conflicts is released, the patient’s anxiety lessens.
Psychotherapy involves an emotionally charged, confiding interaction between a trained therapist and a mental patient.
Dissatisfied with hypnosis, Freud developed the method of free association to unravel the unconscious mind and its conflicts.
The patient lies on a couch and speaks about whatever comes to his or her mind.
Biomedical therapy uses drugs or other procedures that act on the patient’s nervous system, curing him or her of psychological disorders.
During free association, the patient edits his thoughts, resisting his or her feelings to express emotions. Such resistance becomes important in the analysis of conflict-driven anxiety, as the therapist provides an interpretation to provide insight.
Eventually the patient opens up and reveals his or her innermost private thoughts, sometimes developing positive or negative feelings (transference) towards the therapist that reflect the feelings you had towards people in your past
Aaron Beck (1979) suggests that depressed patients believe that they can never be happy (thinking) and thus associate minor failings (e.g. failing a test [event]) in life as major causes for their depression.
Meichenbaum (1977, 1985) trained people to restructure their thinking in stressful situations
Beck believes that cognition such as “I can never be happy” need to change in order for depressed patients to recover. This change is brought about by gently questioning patients.
Rabin et al., (1986) trained depressed patients to record positive events each day, and relate how they contributed to these events. Compared to other depressed patients, trained patients showed lower depression scores
“Relax, the exam may be hard, but it will be hard for everyone else too. I studied harder than most people. Besides, I don’t need a perfect score to get a good grade.”
An eclectic approach uses various forms of healing techniques depending upon the client’s unique problems.
We will look at four major forms of psychotherapies based on different theories of human nature:
Cognitive therapists often combine the reversal of self-defeated thinking with efforts to modify behavior.
The first formal psychotherapy to emerge was psychoanalysis, developed by Sigmund Freud.
Cognitive-behavior therapy aims to alter the way people act (behavior therapy) and alter the way they think (cognitive therapy).
Maltreatment of the insane throughout the ages was the result of irrational views. Many patients were subjected to strange, debilitating, and downright dangerous treatments.
Like clients, clinicians believe in therapy’s success. They believe the client is better off after therapy than if the client had not taken part in therapy.
It is difficult to gauge the effectiveness of psychotherapy because there are different levels upon which its effectiveness can be measured
If you ask clients about their experiences of getting into therapy, they often overestimate its effectiveness. Critics however remain skeptical.
Therapy that applies learning principles to the elimination of unwanted behaviors.
To treat phobias or sexual disorders, behavior therapists do not delve deeply below the surface looking for inner causes.
Humanistic therapists aim to boost self-fulfillment by helping people grow (as opposed to curing illness) in self-awareness and self-acceptance
Counterconditioning is a procedure that conditions new responses to stimuli that trigger unwanted behaviors.
A type of exposure therapy that associates a pleasant, relaxed state with gradually increasing anxiety-triggering stimuli commonly used to treat phobias
Expose patients to things they fear and avoid. Through repeated exposures, anxiety lessens because they habituate to the things feared.
A type of counterconditioning that associates an unpleasant state with an unwanted behavior. With this technique, temporary conditioned aversion to alcohol has been reported.
It is based on classical conditioning and includes exposure therapy and aversive conditioning.
Which psychotherapy would be most effective for treating a particular problem?
Clinical psychologists: They have PhDs mostly. They are experts in research, assessment, and therapy, all of which is verified through a supervised internship.
How can we objectively measure the effectiveness of psychotherapy?
Developed by Carl Rogers, client-centered therapy is a form of nondirective humanistic therapy.
The therapist engages in active listening and echoes, restates, and clarifies the patient’s thinking, acknowledging expressed feelings.
Operant conditioning procedures enable therapists to use behavior modification, in which desired behaviors are rewarded and undesired behaviors are either unrewarded or punished.
In institutional settings, therapists may create a token economy in which patients exchange a token of some sort, earned for exhibiting the desired behavior, for various privileges or treats.
The therapist listens to the needs of the patient in an accepting and non-judgmental way, addressing problems in a productive way and building his or her self-esteem and self-understanding.
Unconditional Positive Regard - a caring, accepting, nonjudgmental attitude, which Carl Rogers believed would help clients to develop self-awareness and self-acceptance
Clinical or Psychiatric Social Worker: They have a Masters of Social Work. Postgraduate supervision prepares some social workers to offer psychotherapy, mostly to people with everyday personal and family problems.
Meta-analysis of a number of studies suggests that thousands of patients benefit more from therapy than those who did not go to therapy.
Counselors: Pastoral counselors or abuse counselors work with problems arising from family relations, spouse and child abusers and their victims, and substance abusers.
Research shows that treated patients were 80% better than untreated ones.
Psychiatrists: They are physicians who specialize in the treatment of psychological disorders. Not all psychiatrists have extensive training in psychotherapy, but as MDs they can prescribe medications.
Type of therapy selected should be evidence-based and should consider patient characteristics and preferences
Philippe Pinel in France and Dorthea Dix in America founded humane movements to care for the mentally sick.
Family therapy treats the family as a system. Therapy guides family members toward positive relationships and improved communication.
Group therapy normally consists of 6-9 people attending a 90-minute session that can help more people and costs less. Clients benefit from knowing others have similar problems.
Psychopharmacology is the study of drug effects on mind and behavior.
Classical antipsychotics [Chlorpromazine (Thorazine)]: Remove a number of positive symptoms associated with schizophrenia such as agitation, delusions, and hallucinations
These include physical, medicinal, and other forms of biological therapies:
Atypical antipsychotics [Clozapine (Clozaril)]: Remove negative symptoms associated with schizophrenia such as apathy, jumbled thoughts, concentration difficulties, and difficulties in interacting with others.
Antidepressant drugs like Prozac, Zoloft, and Paxil are Selective Serotonin Reuptake Inhibitors (SSRIs) that improve the mood by elevating levels of serotonin by inhibiting reuptake.
Clozapine (Clozaril) blocks receptors for dopamine and serotonin to remove the negative symptoms of schizophrenia.
Preventing psychological disorders means removing the factors that affect society. Those factors may be poverty, meaningless work, constant criticism, unemployment, racism, and sexism.
Lithium Carbonate, a common salt, has been used to stabilize manic episodes in bipolar disorders. It moderates the levels of norepinephrine and glutamate neurotransmitters.
Antianxiety drugs (Xanax and Ativan) depress the central nervous system and reduce anxiety and tension by elevating the levels of the Gamma-aminobutyric acid (GABA) neurotransmitter.
With the advent of drugs, hospitalization in mental institutions has rapidly declined.
To test the effectiveness of a drug, patients are tested with the drug and a placebo. Two groups of patients and medical health professionals are unaware of who is taking the drug and who is taking the placebo.
Electroconvulsive Therapy (ECT)
ECT is used for severely depressed patients who do not respond to drugs. The patient is anesthetized and given a muscle relaxant. Patients usually get a 100 volt shock that relieves them of depression.
Modern methods use stereotactic neurosurgery and radiosurgery (Laksell, 1951) that refine older methods of psychosurgery.
Transcranial Magnetic Stimulation (TMS)
In TMS, a pulsating magnetic coil is placed over prefrontal regions of the brain to treat depression with minimal side effects.
Psychosurgery is used as a last resort in alleviating psychological disturbances. Psychosurgery is irreversible. Removal of brain tissue changes the mind.